<?php

require_once("retreivePlanholderInfoController.php");
//require_once("editPlanholderController.php");
//private $edit;
$ret = new retreivePlanholderInfoController;

?>

<html>
	<head>
	<title>Edit Planholder</title>
	</head>
	


	<body>
	<table>
		
	
	
	<?php

	$result = $ret -> sendEditPlanholderRequest($_REQUEST['Policy_no']);	


	

	$row = mysql_fetch_array($result);
	
	echo 
	"<form action=\"editPlanholderController.php\" method=\"post\">
		Policy Number:<input type=\"hidden\" name=\"policyNumber\" value=\"".$row['Policy_no']."\" />
		<br/>
		First Name:<input type=\"text\" name=\"firstName\" value=\"".$row['First_name']."\" />
		<br/>
		Last Name:<input type=\"text\" name=\"lastName\" value=\"".$row['Last_name']."\" />
		<br/>
		Middle Initial:<input type=\"text\" name=\"middle\" value=\"".$row['Middle_name']."\" />
		<br/>
		Type of Plan<select name=\"type\">

							<option value=\"Harmonious\">Harmonious</option>
							<option value=\"Glorious\">Glorious</option>
							<option value=\"Fraternal\">Fraternal</option>
							<option value=\"Equitable\">Equitable</option>
							<option value=\"Divinity\">Divinity</option>
							<option value=\"Celebrity\">Celebrity</option>
							<option value=\"Bossom\">Bossom</option>
							<option value=\"Supreme\">Supreme</option>
						</select>
			<br/>

			Mode of Payment<select name=\"mode\">
								<option value=\"Monthly\">Monthly</option>
								<option value=\"Quarterly\">Quarterly</option>
								<option value=\"Semi-annually\">Semi-annually</option>
								<option value=\"Annually\">Annually</option>
							</select>
			<br/>

		Birthday:<input type=\"text\" name=\"birthday\" value=\"".$row['Bday']."\" />
		Application Number:<input type=\"text\" name=\"applicationNo\" value=\"".$row['Application_no']."\" />
		<br/>
		Term:<input type=\"text\" name=\"term\" value=\"".$row['Term']."\" />
		<br/>
		Plan Value:<input type=\"text\" name=\"planValue\" value=\"".$row['Plan_value']."\" />
		<br/>
		Effective Date:<input type=\"text\" name=\"effectiveDate\" value=\"".$row['Effective_date']."\" />
		<br/>
		Due Date:<input type=\"text\" name=\"dueDate\" value=\"".$row['Due_date']."\" />
		<br/>
		Branch:<input type=\"text\" name=\"branch\" value=\"".$row['Branch']."\" />
		<br/>
		
		<input type=\"submit\" value=\"Save Changes\" />
	</form>";

	?>
		</table>
		
	</body>
</html>